E-Cigarette- and Vaping-Related Lung Injury (EVALI) at a Regional Hospital System in South Carolina

Abstract

We report on four cases of severe lung injury and respiratory failure attributed to E-cigarette use that presented between July and August, 2019. The patients described were relatively healthy without clinically significant history of lung disease. Each developed severe acute respiratory distress shortly following E-cigarette use. In each case, the patients initially presented with considerable hypoxia and infectious-appearing pattern with elevated inflammatory markers on laboratory values. Imaging studies demonstrated a consistent pattern of widespread bilateral interstitial infiltrates with a medial distribution. All but one of the cases involved the admitted use of THC oil in E-cigarettes. There was rapid progression of illness requiring increased supplemental oxygen and in two cases, requiring urgent intubation and mechanical ventilation. No infectious organism was isolated in any case, and patients improved rapidly with the initiation of steroids. These are among the first cases reported in South Carolina and are consistent with similar cases that have been reported around the country.

Treatment of electronic cigarette or vaping product use‐associated lung injury (EVALI) by corticosteroid and low‐dose pirfenidone: Report of a case

“…The optimal treatments for EVALI are still yet to be established. Several recent studies suggested that corticosteroids may be beneficial for these patients, 12–14 but it is also possible for patients to recover without corticosteroids or by avoiding vaping. Moreover, the dosage and duration of corticosteroid use varied widely in previous reports 12–14 .…”

“…Several recent studies suggested that corticosteroids may be beneficial for these patients, 12–14 but it is also possible for patients to recover without corticosteroids or by avoiding vaping. Moreover, the dosage and duration of corticosteroid use varied widely in previous reports 12–14 . In a case series of hospitalized EVALI cases, the most typical steroid regimen was methylprednisolone 40 mg every 6–12 h 13 .…”

“…Moreover, the dosage and duration of corticosteroid use varied widely in previous reports. 12 , 13 , 14 In a case series of hospitalized EVALI cases, the most typical steroid regimen was methylprednisolone 40 mg every 6–12 h. 13 The patients were discharged on a prednisone taper, with a median steroid use of 24.5 days. In that study, all patients had complete resolution of symptoms and ground‐glass opacities on HRCT within 3 weeks.…”

COVID-19 and the role of e-cigarette use: An evidence-based review

“…These studies have shown that exposure to vapour of e-cigarettes can disrupt pulmonary homeostasis with increased airway inflammation, oxidative stress and risk of respiratory infection, decreased lung function and immunity. [15,18,[24][25][26]. Moreover, e-cigarettes cause a significant induction of inflammation in the lungs through a different dysregulated immune landscape.…”